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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

JOB SUMMARY

The Medical Billing Specialist is responsible for the accuracy of the super bill/claim prior to transmission to payer, including validation of appropriate Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).

DUTIES & RESPONSIBILITIES

The Billing Specialist job description is intended to point out major responsibilities within the role, but it is not limited to these items.

• Assign/remove CPT, HCPCS and modifiers as part of the super bill/claim validation process.

• Prepare and review super bill/claims prior to submission.

• Identify coding trends and opportunities to improve quality, efficiency and productivity.

• Checking each insurance payment for accuracy.

• Ensure compliance with billing and payers' guidelines.

• Calling insurance companies regarding any discrepancy in payments if necessary

• Researching and appealing denied claims.

EDUCATION AND PROFESSIONAL EXPERIENCE

(Licensures AND Certifications)

• High school diploma or GED equivalent

• Minimum of 1 year of experience as a medical biller.

PROFESSIONAL COMPETENCIES

• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.

• Knowledge of CPT, ICD-10-CM and HCPCS codes.

• Knowledge of coding principles and guidelines.

• Knowledge of billing principles and guidelines.

• Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services.

• Excellent written and verbal communication skills

• Prefer certification as any of the following - American Academy of Professional Coder (AAPC) Certified Professional Coder (CPC) or American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS).

• Bilingual English and Spanish required.